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Date_12/3 93 9 MU(c, (IPd WQK! <br />pplitatlon For <br />PUBLIC ORKS PERMIT <br />Print or Type Only <br />Eger -Irvine 8128�18tM S4r Sdmonds 5W020 778-7485 <br />Owner \Rating� Addttr;e�s((5 , 5, City <br />Ofll Uri tot <br />Phil King 745- 33 SO m DO g <br />Mailing <br />New duplex <br />Describe Proposed Work <br />Protect Address (if known) <br />Lilly <br />Public Worke Pefmll • J ` / <br />eldp Dept. e 4 _882 <br />Public Worke Fee <br />Total Fee <br />Lest APPI. Fee Paid It �_ <br />Babnce Due it 2,7 <br />r <br />Zip Phone <br />Attach four (4) copies rt plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Centerline Of street <br />• Outline ind dimensions of all existing and <br />• Indicate North <br />propoFed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDI I IONS <br />1. All calls for Inspection shall be mcde 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />% !/C't'c't. s <br />�JroPer �Yt 7r0.1> 4'9 . <br />i-�. rl�-4,Thlt'cC.r�.y'In��'�x>r7'Q�.ei a...al'P.cf+�t.i�!!'c/.1r�S-lo+w.uett/�,,�*�khz.Ea ,o•lof�rcfoz. <br />S Ave oli-,vewnQc•Cess gncl.Dar�i�y S�bcds. <br />9 <br />.see lnak,ei<eo 1,jrtke Z,, , an � <br />wale"- <br />Conneclo�s , <br />4Sa.-in,f(L�r Sy if4 inL /%'1as A <br />pr /cFie+P71G 400rty <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8810 <br />b.Ootlu.T� n � draw, a�p <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />O <br />U) <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for damages. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City awl to replace p blic pro ty damaged thereby. <br />Signature of Applicant U Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COh'PLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON A14Y STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIi,N. <br />